How Nurses Can Help End Horizontal Hostility in Three Easy Steps

Hospitals make stressful workplaces. Patients are sicker than ever, nurses are in short supply, and many nurses are getting older. Plus, many groups and individuals often care for one patient, setting up power struggles and an “us-versus-them” mentality, says Melissa Fitzpatrick, RN, MSN, FAAN, chief healthcare strategist with business intelligence software provider SAS Institute and former chief nurse executive at Duke University Medical Center.

Hostility among nurses resembles that of other oppressed groups, says Kathleen Bartholomew, RN, MN, whose pre-nursing background was in sociology. After doctors yell at them, nurses may take it out on coworkers. And when people work harder and faster without time to debrief, they act out, says Bartholomew, author of Ending Nurse-to-Nurse Hostility: Why Nurses Eat Their Young and Each Other.

Generational differences can also create strife when values, communication styles and skill sets clash. In addition, conflict can arise when nurses and institutional practices mishandle the integration of new nurses — an unfortunately common occurrence given the nursing shortage.

Step 2: Realize the Cost

“Nurses who are doing the negative talking, putting others down, don’t realize the damage they are doing,” Bartholomew says. Negativity leads to a sense of isolation and torpedoes teamwork. “You end up with a life-preserver attitude instead of a lifeboat mentality,” she says. “It becomes ‘every man for himself’ rather than ‘we’re all in this together.’”

Poor teamwork and communication can also spell trouble for patients, Bartholomew says. She almost lost a patient herself when a coworker, upset by a colleague’s comments, programmed the pain machine incorrectly, dispensing the wrong dose.